Department of Pediatrics, Penn State College of Medicine, Hershey, PA.
Department of Pediatrics, Penn State College of Medicine, Hershey, PA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA.
J Pediatr. 2022 Dec;251:172-177. doi: 10.1016/j.jpeds.2022.07.036. Epub 2022 Aug 6.
To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD).
Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression.
The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment.
Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth.
ClinicalTrials.gov: NCT03716869.
通过对 SHIELD（在高中筛查以识别、评估和降低抑郁）随机临床试验数据的二次分析，评估青少年自杀风险筛查对增加心理健康服务启动的效果。该试验评估了针对重度抑郁症（MDD）的基于学校的筛查。
14 所宾夕法尼亚州高中的学生按年级随机分为两组，一组为针对自杀风险行为的有针对性转诊的常规学校实践，另一组为使用患者健康问卷-9（PHQ-9）的普遍筛查，任何关于自杀风险的第 9 项回答>0 均被视为阳性。这两个组别的学生都被推荐到学生援助计划（SAP），SAP 在宾夕法尼亚州所有学校都是强制性的。SAP 确定了后续措施。使用混合效应逻辑回归比较了研究组。
共有 12909 名参与者，其中 6473 名（50.1%）被随机分配到普遍筛查组。研究组中有 46%的女性和 43%的西班牙裔或非西班牙裔黑人。普遍筛查组的青少年自杀风险识别的可能性高 7.1 倍（95%CI，5.7-8.8），需要后续治疗的可能性高 7.8 倍（95%CI，4.6-13.1），开始心理健康治疗的可能性高 4.0 倍（95%CI，2.0-7.9）。
尽管 PHQ-9 是一种 MDD 筛查工具，但在普遍筛查中使用它增加了自杀风险青少年的识别和治疗启动。这证实了普遍筛查的价值，并表明针对自杀的特定风险评估将对识别出的青少年的治疗启动产生更大的影响。
ClinicalTrials.gov：NCT03716869。
